How To Use CPT Code 91111

CPT 91111 describes the procedure for gastrointestinal tract imaging, specifically intraluminal imaging using capsule endoscopy to evaluate the esophagus. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 91111?

CPT 91111 is used to describe the procedure of gastrointestinal tract imaging, specifically intraluminal imaging using capsule endoscopy to evaluate the esophagus. This code is used when a provider performs capsule endoscopy for imaging of the esophagus and interprets the images to prepare a report.

2. Official Description

The official description of CPT code 91111 is: ‘Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus with interpretation and report.’ It is important to note that this code should not be reported in conjunction with codes 91110, 91113, or 0651T. Incidental visualization of other parts of the gastrointestinal tract, such as the stomach, duodenum, ileum, and/or colon, should not be reported separately.

3. Procedure

1. The patient is appropriately prepped for the procedure.
2. The provider gives the patient an activated endoscopic capsule to ingest with normal water.
3. The capsule passes through the esophagus, taking color images of the esophageal lumen as it moves.
4. The provider may ask the patient to change positions at certain time intervals to ensure complete imaging.
5. Image recording sensors are placed on the patient’s abdomen to capture the images sent by the capsule’s antenna.
6. The patient is left for one hour for image recording, which is the amount of time needed to examine only the esophagus.
7. After the procedure, the capsule passes out with a bowel movement within a day.
8. The provider transfers the recorded data from the image recording sensor to a computer.
9. The recorded data is analyzed and interpreted by the provider.
10. A written report is prepared based on the analysis and interpretation of the recorded data.

4. Qualifying circumstances

CPT 91111 is used when a provider performs capsule endoscopy for gastrointestinal tract imaging of the esophagus. It is important to note that incidental visualization of other parts of the gastrointestinal tract should not be reported separately. The provider must interpret the images and prepare a report based on the findings.

5. When to use CPT code 91111

CPT code 91111 should be used when a provider performs capsule endoscopy specifically for imaging of the esophagus. It should not be used for imaging of other parts of the gastrointestinal tract. If the procedure involves imaging from the esophagus to the ileum, CPT code 91110 should be used instead.

6. Documentation requirements

To support a claim for CPT 91111, the provider must document the following information:

• Patient’s preparation for the procedure
• Details of the capsule endoscopy procedure, including the ingestion of the capsule and the placement of image recording sensors
• Date and duration of the procedure
• Specific findings and interpretation of the recorded data
• Preparation of a written report based on the analysis and interpretation

7. Billing guidelines

When billing for CPT 91111, it is important to append the appropriate modifiers to indicate whether the service is for the professional component (modifier 26) or the technical component (modifier TC). If both components are provided by the same provider, no modifiers are necessary. It is also important to note that CPT code 91111 should not be reported in conjunction with codes 91110, 91113, or 0651T.

8. Historical information

CPT 91111 was added to the Current Procedural Terminology system on January 1, 2007. There have been no updates to the code since its addition. However, on January 1, 2013, the description of the code was changed to include ‘with physician interpretation and report.’

9. Examples

1. A gastroenterologist performs capsule endoscopy specifically for imaging of the esophagus and interprets the images to prepare a report.
2. A physician administers an activated endoscopic capsule to a patient and places image recording sensors on their abdomen. The recorded data is later analyzed and interpreted to prepare a written report on the esophageal findings.
3. A healthcare provider performs capsule endoscopy to evaluate the esophagus of a patient with suspected abnormalities. The recorded data is analyzed and interpreted, and a report is prepared based on the findings.
4. A gastroenterologist uses capsule endoscopy to assess the esophageal lumen of a patient with a history of esophageal disorders. The recorded data is analyzed and interpreted, and a report is generated to document the findings.
5. A medical professional performs capsule endoscopy specifically for imaging of the esophagus in a patient with symptoms of esophageal abnormalities. The recorded data is analyzed and interpreted, and a report is prepared to provide diagnostic information.
6. A gastroenterologist utilizes capsule endoscopy to examine the esophagus of a patient with suspected esophageal pathology. The recorded data is analyzed and interpreted, and a report is generated to document the findings.